Residents of Yarmouk queuing for food in January 2014. Once home to 145,000 Palestinian refugees, the town has been taken over by Islamic State militants, forcing most residents and aid workers to leave and isolating those left behind. Photo: UNRWA

Anaesthesia, antibiotics, blood, saline, replacement joints, frames: none of these basics have been available in Yarmouk or the surrounding towns for almost a year. "We are back to the Stone Age, where we are using wooden stakes to adjust the bones of patients," Dr Issa, 31, told Fairfax Media via Skype.

"We use these primitive arrangements, while the families of the injured must find some kind of medical supplies ... if any medications come from outside, it is very limited and it is smuggled through the checkpoint."

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Next month will mark the one-year anniversary of the day Yarmouk ceased to have access to water. There is no fuel. Depression and anxiety among the estimated 12,000 people left inside has reached crisis point.

Starvation and malnutrition are common and now residents report the highly contagious disease typhoid is taking hold.

Charity staff distribute aid to the residents of the besieged Yarmouk camp in March.
Photo: Alamy

Amid this death and chaos, the United Nations, which has been unable to access Yarmouk since March, has inexplicably removed the neighbourhood from its list of besieged areas.

Salim Salamah, from the Palestinian League for Human Rights Syria, a former citizen of Yarmouk who now lives in exile in Sweden, said the UN decision to reclassify Yarmouk was met with incredulity by those living under devastating conditions.

"People are gradually losing their minds," Mr Salamah said.

"In order to reach Yalda, the closest neighbourhood to Yarmouk, you have to walk 35 minutes for nearly three kilometres," he said. "For people who are suffering malnutrition, this is a long way to walk."

The Islamic State and the Nusra Front are constantly assassinating civilian activists inside Yarmouk.

Abdullah al-Khateeb

The area is under constant aerial bombardment from the Syrian regime, there are snipers on all sides and anyone caught at a checkpoint risks arrest and torture.

Aid is distributed near Yalda on an irregular basis, but distribution is unreliable, so many people are left wondering where their next meal will come from, Mr Salamah said.

A UN spokeswoman, Amanda Pitt, said the reclassification did not mean the UN had "deprioritised" the people of Yarmouk.

She referred Fairfax Media to a statement by UN emergency relief co-ordinator Stephen O'Brien, who said at the time of the reclassification in late June: "The real issue here is that whatever aid is reaching people is not enough by a long stretch, and the humanitarian situation in Yarmouk is very bad."

Chris Gunness, spokesman for the United Nations Relief and Works Agency, the body responsible for Palestinian refugees, said the situation was as dire as ever. "We have not had access to Yarmouk since March 28, shortly before [Islamic State] moved into the camp.

"To me the question is not so much is there a siege, but are we seeing violations of international humanitarian law and will there be accountability?"

Yarmouk, a once-crowded neighbourhood that was home to 145,000 Palestinian refugees and their families, lies just eight kilometres from Damascus.

More than four years of war have left the town in ruins, devastated by barrel bombs dropped by the Syrian air force and vicious fighting among the armed groups inside the camp.The regime of Syrian President Bashar al-Assad cut access to basic infrastructure more than a year ago.

And since fighters from the Islamic State group took control of much of the camp on April 1, there has been an exodus of medical and healthcare workers, who have been relentlessly targeted and murdered by the extremist group.

Many have moved the three kilometres to the neighbouring town of Yalda, which is under the control of Syrian rebel forces. "I and other medical workers had to move towards Yalda to escape the bloodthirsty ideas of Daesh [Islamic State], who are against anyone who doesn't agree with them," Dr Issa said.

"We also didn't want to offer our services to Daesh or to other extremist groups."

Activist Abdullah al-Khateeb was forced to flee Yarmouk for Yalda the day IS entered his neighbourhood and raided his house, issuing death threats against the young writer and final-year sociology student, who spends his time documenting human rights violations in a war that has claimed as many as 230,000 lives.

"In the southern part of Damascus, Yalda is part of seven towns that are entirely besieged," Mr Khateeb, 26, told Fairfax Media via Skype.

The towns are divided: Yarmouk, Qadam, Tadamon and al-Hajar al-Aswad are all controlled by IS and the al-Qaeda-affiliated Nusra Front, while Yalda, Babila and Beit Sahem are under the control of other rebel forces, according to Mr Khateeb.

And while these last three towns are under a temporary ceasefire with the Syrian regime, humanitarian aid is very limited. Inside Yarmouk, no aid at all was being distributed, Mr Khateeb said.

"The situation is extremely unstable," he said. "The Islamic State and the Nusra Front are constantly assassinating civilian activists inside Yarmouk."